Académique Documents
Professionnel Documents
Culture Documents
RksYgsuxaPi)al
RBHraCaNacRkkm<úCa
e)aHBum<elIkTI1
Ex kumÖ³ qñaM 2007
First Publication
February 2007
Table of Content
1
Chapter 4- Methodologies to Introduce Clients’ Rights and
Providers’ Rights-Dutie .................................................................. 25
At central level............................................................................... 25
At provincial level .......................................................................... 25
At health facility level (hospitals and health centres) .................... 26
At community level ........................................................................ 27
Chapter 5 - Advocacy Support ....................................................... 28
At central ministry level ................................................................. 28
At provincial and OD level............................................................. 28
At health facility level .................................................................... 28
At community level ........................................................................ 29
Chapter 6 – Supervision and Monitoring ...................................... 30
At health centre and community level ........................................... 30
At hospital level ............................................................................. 30
Chapter 7- Evaluation and consolidation ..................................... 32
Glossary ........................................................................................ 33
2
Preface1
In 2004 the Ministry of Health created a working group to develop a
national standardised package for clients’ rights and providers’ rights-
duties. With support from the German Technical Cooperation (GTZ),
this package of activities were finalised at the end of 2006.
Minister of Health
Dr. Nuth Sokhom
1
Unofficial translation from the Khmer version
3
The working group members who developed the clients’ rights
and providers’ rights-duties packages and the operational
guidelines.
4
Operational guidelines for implementing
Clients’ rights and Providers’ rights-Duties
Chapter 1
1. Introduction
The purpose of these guidelines is to provide practical
information, strategies and techniques for the promotion and
advocacy of clients’ rights and providers’ rights-duties in the
health care system of Cambodia. The guidelines provide
information about the rights, their definition and the
responsibilities of both clients and providers. They also outline
strategies and practical techniques that help ensure appropriate
and effective implementation and monitoring of the rights and
duties.
2. Background
The promotion of clients’ rights and providers’ rights-duties is one
of the goals of the Behaviour Change Communication (BCC) key
area of work in the current Health Sector Strategic Plan. The
rights aim at fostering changes in attitude and behaviour towards
effective health service delivery and greater health empowerment
of the Cambodian people.
5
The right to health care is one of the three values stipulated in the
Health Sector Strategic Plan for 2003-2007 of the Ministry of
Health alongside Equity and Pro-poor.
6
Chapter 2 Guidelines and Techniques for the Implementation of
Clients’ Rights
1.2 Application
1.2.1 Health care providers should provide the best
possible quality of health care to all clients;
regardless race, ethnicity, colour, poverty, sex,
marital status, physical or mental disability and
illnesses, age, language, religion, political orientation,
national or social origin.
7
1.2.3 Through the decentralised structure, commune
councils should have a role in providing clear
explanation on client rights to all their community
members. The commune council should also make
sure that the poor are aware of their rights and
provide advocacy support where needed.
8
diagnosis, prognosis and progress of treatment; and
what to do in the event of an emergency.
2.2 Application
2.2.1 Persons responsible for individual health care
facilities should ensure that information about health
care services is publicly visible. That information
includes working hours, price list and patient flow
within health care facilities.
9
1) health staff that overlooks their care, 2) what to do
in case of need or emergency, 3) access to toilets,
water, electricity supply and food, 4) rules and
regulations of the hospital including payment
procedures.
10
3. Right to health care and treatment
3.1. Key concepts
3.1.1. All persons have the right to receive such health care
as is appropriate to his or her health needs, including
preventive care and health promotion activities.
Special attention should be provided particularly
during an emergency.
3.1.7. Clients have the right to terminal care and the right to
die in dignity.
3.2. Application
3.2.1. According to the human, financial and material
resources available, health facilities should make
services continuously available and accessible
equally to all without any discrimination.
11
3.2.2. The MOH should ensure adequate supply of financial
and human resources, material/equipment and drugs
to health facilities.
12
3.2.8. To ensure the quality health care of providers, the
MOH will enhance and update the knowledge and
skills of its health providers through a regular
capacity building programme.
13
4. Right to confidentiality
4.1. Key concept
Clients have the right to confidentiality of all information on
their health status, medical condition, diagnosis, prognosis,
and treatment and all other information of a personal kind,
even after death of the client.
4.2. Application
4.2.1. Health facility managers and persons responsible
should make sure all clients’ files; registrar and
database are kept in a safe place.
14
4.2.7. Health facility managers and persons responsible
should make sure that all identifiable client data are
properly protected. Human substances, e.g. blood,
tissues and other organic matter from which
identifiable data can be derived, must be properly
disposed of or kept in a safe place.
5. Right to privacy
5.1. Key concept
Clients admitted to or visiting health care facilities have the
right to expect facilities that ensure privacy, particularly
when health care providers are carrying out physical
examinations and treatment.
5.2. Application
5.2.1. All health care institutions should have adequate
facilities to ensure privacy of the clients during the
course of medical interventions. This means that a
given intervention must be carried out in a closed
room and only in the presence of those persons who
are necessary for the intervention.
15
5.3. Clients’ responsibilities
Clients are responsible to inform health care providers about
the privacy they need and provide feedback information for
improvement.
6.2. Application
6.2.1. Health care providers should provide clients with as
much information as possible on the choices of care
and treatment and the pros and cons of each
intervention, and recommend the best options in
order for clients to make the appropriate decisions for
their medical care.
16
6.2.5. If a client or representative refuses to give consent
and the physician or other provider is of the opinion
that the intervention is in the interest of the client’s
life, then the decision must be referred to the health
facility board or technical committee.
17
7. Right to express opinion and to participation
7.1. Key concepts
7.1.1. Clients have the right to express their opinions
regarding the health care services they received.
7.2. Application
7.2.1. Health care providers should take opinions
expressed by clients and/or their representatives as
constructive feedback information for themselves and
the health facilities they work in. They should handle
this feedback systematically and promptly whenever
possible.
18
providing the true information related to evidence
requested.
19
Chapter 3 - Guidelines and Techniques for the Implementation of
Providers’ Rights-Duties
1.2 Application
1.2.1 In order to contribute to proper diagnosis and
treatment, clients, as mentioned in their
responsibilities, should cooperate with health care
providers in giving a complete and accurate
information related to their current and past health
problems.
20
health care services according to capacity of medical
facilities that are available. In case the patient
requested to be transferred to other health facilities,
provider may agree with the request with a clear
explanation about possible problems happening
during transportation.
2.2. Application
2.2.1. Providers should make sure that services available at
their health facilities are informed to the public. They
can use posters, leaflets, mass media or existing
communication channel e.g. VHSG, VHV, Health
21
Centre Management Committees etc. to disseminate
service information to the public.
22
3. Rights and Duties in confidentiality
3.1. Key concept
Providers have the duties to keep confidential of all
information on clients' health status, medical condition,
diagnosis, prognosis, and treatment and all other
information of a personal kind, even after death of the client
from outsiders.
3.2. Application
3.2.1. Clients’ relatives, representatives or any individual
should respect the confidential measures/system
applied by health care providers. They should not
coerce health care providers to give or disclose of
any health information unless consent made by
concerned clients or there is required by law.
23
tissues and other organic matter from which
identifiable data can be derived, must be properly
disposed of or kept in a safe place.
4.2. Application
4.2.1. Clients or relatives should cooperate with their health
care providers’ decision on referral to other health
care facilities.
5. Providers’ Responsibilities
24
Chapter 4- Methodologies to Introduce Clients’ Rights and
Providers’ Rights-Duties
At central level
The first entry point is the official launching of clients’ rights and
providers’ rights-duties. This will be done through a national workshop
presided by high officials from the Ministry of Health (MoH), Ministry
of Justice as well as the Municipal Mayor of Phnom Penh. Main
stakeholders will be invited to participate. They are representatives of
medical council, health professional groups/associations,
communities, labour unions, lawyers, human right organisations and
health partners.
Electronic media like TV and radio spots and other IEC materials like
leaflets, brochures and posters will be produced at the central level to
further publicize clients' and providers' rights-duties nationwide. The
MoH website is another possible medium of dissemination. The
National Centre for Health Promotion and the Department of
Preventive Medicine are responsible for activities at central level.
At provincial level
Just like with other policies, guidelines and standards, the Provincial
Health Departments and Operational Districts are playing important
roles in orientation, dissemination and monitoring the implementation
of clients’ rights and providers’ rights-duties in their province and
districts.
2
Orientation modules will be developed separately from this document
25
or facilitators team from the MoH (Department of Preventive Medicine
and National Centre for Health Promotion) will assist the provincial
health department and operational district in conducting the training
workshops. The team will also assist in further dissemination at health
facility and community levels.
26
The first phase of implementation of these rights is planned in five
provinces namely Kampot, Kampong Thom, Pursat, Kampong Cham
and Siem Reap. It will apply in different performing health facilities i.e.
good, fair and poor according to the Ministry of Health’s criteria.
At community level
Introducing the concept of clients’ rights and providers’ rights-duties
to the villagers in their communities will be accomplished through
several means. The participants attending the training workshop at
the provincial with assistance of existing health partners or other civil
society organisations will introduce the following activities:
27
Chapter 5 - Advocacy Support and Redresses for Non
Compliance
28
needed. They will refer cases that cannot be handled at hospital level
to the provincial health professional councils.
At community level
Local authorities, particularly the trained commune councils, play
important roles in providing advocacy support to community
members. They will assist in the clarification of clients’ rights and
providers’ rights-duties when needed. They will provide mediation
services, assist in the filling of complaints and refer to the appropriate
bodies for further resolution.
29
Chapter 6 – Supervision and Monitoring of Clients' Rights and
Providers’ Rights
At hospital level
Hospital Management Committees4 and representative of local
authority are responsible for supervision and monitoring of the
implementation. Supervision will be done through direct observation o
3
They will be trained on how to conduct supervision and monitoring through
orientation modules
4
same as number 2
30
f hospital staff and client interviews on a monthly basis. They will
provide oral feedback and recommendation to staff and produce a
written report. The report will be communicated to the operational
district chief, commune councils and hospital staff. This report will be
used as a tool for follow up.
31
Chapter 7- Evaluation and consolidation
After drawing lessons learnt, the working group will consolidate the
clients’ rights and providers’ rights-duties packages, the approaches
and strategies for further effective implementation of these rights-
duties throughout the country.
32
Glossary
33